Primary and Metastatic Parathyroid Malignancies: A Rare or Underdiagnosed Condition?

2015 ◽  
Vol 100 (3) ◽  
pp. E478-E481 ◽  
Author(s):  
Alexander Shifrin ◽  
Virginia LiVolsi ◽  
Svetlana Shifrin-Douglas ◽  
Min Zheng ◽  
Brian Erler ◽  
...  
Keyword(s):  
Parathyroid Gland ◽  
Metastatic Disease ◽  
Parathyroid Carcinoma ◽  
Metastatic Spread ◽  
Endocrine Tumors ◽  
Tumor Spread ◽  
Parathyroid Function ◽  
Parathyroid Neoplasm ◽  
The Rich ◽  
Tumor Types

Objective: Parathyroid gland malignancies are considered rare. The most common of these tumor types is primary parathyroid carcinoma. Metastatic spread from other cancers may also occur with up to 10% of cancers from other sites showing parathyroid involvement at autopsy. Tumor-to-tumor metastases (metastatic spread to parathyroid neoplasm) from remote cancers to the parathyroid gland have been described. Methods: We did a PubMed literature review and analysis of our own experience of 392 consecutive parathyroidectomies. Results: Primary and secondary parathyroid malignancies can be grouped into three categories: primary parathyroid carcinoma (PPCa), spread of carcinoma into parathyroid glands by contiguous extension from the thyroid gland or other head and neck cancer, and metastatic disease to the parathyroid gland from distant cancers. Studies of tumor-to-tumor spread indicate a predilection of spread to endocrine tumors possibly because of the rich blood supply that is present in endocrine tumors. Two of our 392 parathyroidectomies (0.5%) had cancer: one metastatic (thymic neuroendocrine tumor) and another PPCa. Conclusion: Metastatic disease to the parathyroid gland is poorly documented. When performing surgery for primary thyroid cancer, the search for parathyroid gland metastases is often overlooked because of the desire to preserve parathyroid function. Metastatic disease from other cancers to a benign parathyroid gland or to a parathyroid adenoma probably suggests a grave prognosis because it likely indicates widespread metastatic disease; however, isolated metastases to the parathyroid may occur. Although these lesions may be uncommon they may not be as rare as once thought.

Intrathoracic metastatic spread of parathyroid carcinoma

2010 ◽  
Vol 49 (06) ◽  
pp. N62-N62 ◽  
Author(s):  
C. Maier-Funk ◽  
T. Weber ◽  
G. Lang ◽  
S. Hügl ◽  
S. N. Reske ◽  
...  
Keyword(s):  
Parathyroid Carcinoma ◽  
Metastatic Spread

scholarly journals Reversible Catecholamine Induced Cardiomyopathy

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A1005-A1005
Author(s):  
Kathrin Sandra Tofil ◽  
Malek Mushref
Keyword(s):  
Neuroendocrine Tumor ◽  
Metastatic Disease ◽  
Left Ventricular ◽  
Uncontrolled Hypertension ◽  
Endocrine Tumors ◽  
Retroperitoneal Mass ◽  
Distal Pulse ◽  
Hepatic Lesions ◽  
Poor Outcomes ◽  
The Right

Abstract Background: Pheochromocytomas and paragangliomas (PPGL) are rare neuro-endocrine tumors associated with a myriad of poor outcomes as a result of long-term exposure to catecholamines. Although paragangliomas are less commonly associated with increased catecholamine production than adrenal pheochromocytomas, there have been a few reports of catecholamine-induced cardiomyopathy in patients diagnosed with PPGL. We report a case of a PPGL associated with hypercoagulability and cardiomyopathy. Clinical Case: 42-year-old man with uncontrolled hypertension presented to the emergency department with abdominal pain. On CT imaging, he was found to have hepatic lesions, aortocaval lymph node concerning for metastatic disease, left renal infarct, and a left ventricular thrombus. Soon after his admission, he developed acute ataxia, gaze palsies and left hemiparalysis. CTA of the head showed a basilar artery thrombus [FJ1] which was treated with emergent thrombectomy. In addition patient had absent distal pulse of the right foot[FJ2], and found to have thrombus of the popliteal artery, which was treated with thrombectomy. Further workup with abdominal MRI showed retroperitoneal mass[FJ3] and multiple hepatic lesions concerning for metastatic extra-adrenal neuroendocrine tumor. Plasma normetanephrine was 4.5 nmol/L (ULN 0.89), plasma metanephrine 0.3 nmol/L (ULN 0.49) Chromogranin A was 387 ng/ml (ULN 160). Ga-68 DOTATE scan was consistent with an extra adrenal paraganglioma with less prominent radiotracer activity in hepatic lesion concerning for dedifferentiated metastatic disease. In addition, echocardiogram showed reduced LV ejection fraction of 24% with global hypokinesis, and confirmed the LV thrombus. Cardiac MRI showed infiltrative nonischemic cardiomyopathy and mild dilation of left ventricle, as well as patchy delayed enhancement in the basal and inferoseptal walls suggestive of myocarditis. Treatment included rivaroxaban[FJ4], lisinopril, doxazosin, furosemide, and carvedilol. Several months after discharge, his EF improved to 48%. Hepatic lesions concerning for dediffertiated tumor vs unrelated malignancy was biopsied[FJ5] and consistent with neuroendocrine tumor. Future plan for his PPGL include revaluation for resection of retroperitoneal mass or DOTA Lutathera therapy. Conclusions: This case highlights a young man who was incidentally found to have metastatic paraganglioma with catecholamine-induced cardiomyopathy. The patient was asymptomatic until he developed significant heart failure. Cardiomyopathy in this setting is thought to be secondary to uncontrolled hypertension, as well as sympathetic overdrive from overstimulation of norepinephrine. We present the case to highlight the management challenges in a patient with PPGL with significant cardiovascular compromise and limited therapeutic options.

scholarly journals PARATHYROID CARCINOMA WITH INTRATHYROID LOCATION: CASE FROM PRACTICE

2020 ◽  
Vol 23 (2) ◽  
pp. 206-210
Author(s):  
E. L. Kazachkov ◽  
S. V. Sergiyko ◽  
T. E. Il’ina ◽  
I. V. Fominykh ◽  
D. D. Voropaev ◽  
...  
Keyword(s):  
Parathyroid Gland ◽  
Parathyroid Carcinoma ◽  
Thyroid Tissue ◽  
Clinical Manifestations ◽  
Clinical Syndrome ◽  
Background Information ◽  
Invasive Growth ◽  
Parathyroid Tumor ◽  
Clinical Prognosis ◽  
Gender And Age

Carcinoma of the parathyroid gland is a rare malignant tumor of the person, which manifests itself clinical syndrome of hyperparathyroidism. The tumor is characterized by structural signs of invasive growth and is characterized by an unfavorable clinical prognosis, often accompanied by metastasis and the formation of relapses. The article provides background information about the incidence of parathyroid carcinoma, the gender and age characteristics of patients with this disease, options for localization of the tumor in the gland itself (typical topic of the neoplasm), in other areas of the neck, thyroid, thymus, and so on. We discuss the features of clinical manifestations of parathyroid carcinoma, among which the most typical are manifestations of hyperparathyroidism and hypercalcemia, and also provide figures for five - and ten-year survival. The article presents the author’s observation of parathyroid carcinoma with an intrathyroid location in a 64-year-old man. After the examination, the patient underwent a cervicotomy with revision of the areas of the typical location of the parathyroid gland in the neck, hemithiroidectomy on the left with a parathyroid tumor incorporated in the thyroid tissue, which was later proved using immunohistochemical research methods. The article details the macroscopic, microscopic, and immunohistochemical characteristics of the operating material. A special feature of the case is a rare atypical intrathyroid localization of parathyroid carcinoma.

scholarly journals Parathyroid carcinoma

2006 ◽  
Vol 63 (8) ◽  
pp. 765-769
Author(s):  
Aleksandar Filipovic ◽  
Ivan Paunovic ◽  
Dragutin Savjak ◽  
Tamara Zivkovic
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Carcinoma ◽  
Disease Recurrence ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Endocrine Tumors ◽  
En Bloc ◽  
Histologic Diagnosis ◽  
Serum Pth

Background. Parathyroid carcinoma is the least frequent malignancy among endocrine tumors. In the most reported series of patients with primary hyperparathyroidism the incidence of carcinoma is less than 1%. Recognition by a surgeon that the parathyroid tumor is malignant, and the performance of an adequate en bloc removal of primary lesion, with histologic diagnosis offer the best treatment of a patient with this unusual malignancy. Case report. We reported a 30-year-old patient with parathyroid carcinoma, primary hyperparathyroidism, and recurrent nephrocalcinosis. Marked hypercalcemia, low serum phosphorus, and substantial elevation of serum parathyroid hormone indicated a diagnosis of primary hiperparathyroidism. General symptoms were anorexia, muscle weakness, back pain and depression. Ultrasonography done before the surgery revealed a 2 cm upper left parathyroid gland with solid and cystic areas. The neck exploration was done with en block resection of the tumor. A histopathological evaluation confirmed the diagnosis of parathyroid carcinoma. Over more than a three-year-follow-up, the patient had no evidence of the disease recurrence and his serum PTH and calcium levels remained within the normal. Conclusion. Parathyroid carcinoma is a rare cause of primary hyperparathyroidism. Preoperative diagnosis remains a challenge. Radical en bloc resection of the tumor is the treatment of choice for this malignancy.

scholarly journals Parathyroid gland angiography with indocyanine green fluorescence to predict parathyroid function after thyroid surgery

2016 ◽  
Vol 103 (5) ◽  
pp. 537-543 ◽  
Author(s):  
J. Vidal Fortuny ◽  
V. Belfontali ◽  
S. M. Sadowski ◽  
W. Karenovics ◽  
S. Guigard ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Parathyroid Gland ◽  
Thyroid Surgery ◽  
Green Fluorescence ◽  
Indocyanine Green Fluorescence ◽  
Parathyroid Function

Carcinoma Metastatic to a Cerebellar Vascular Malformation: Case Report

Neurosurgery ◽  
1990 ◽  
Vol 26 (6) ◽  
pp. 1054-1057 ◽  
Author(s):  
George M. Greene ◽  
Michael N. Hart ◽  
Marshall M. Poor ◽  
Christopher M. Loftus
Keyword(s):  
Case Report ◽  
Metastatic Disease ◽  
Vascular Malformation ◽  
Metastatic Adenocarcinoma ◽  
The Rich ◽  
Metastatic Neoplasm

Abstract A 73-year-old woman with a spontaneous intracerebellar hemorrhage was seen and was found to have metastatic adenocarcinoma within a vascular malformation. There was no evidence of other metastatic disease. The association of these two lesions is uncommon and has rarely been reported. The rich vascularity of the malformation may explain the hematogenous deposition of metastatic neoplasm at this site.

Metastatic parathyroid carcinoma: Treatment modalities illustrated with a case report.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e16004-e16004
Author(s):  
Alison Marie White ◽  
Samantha Elizabeth Bowyer ◽  
John Andrew Davidson ◽  
David Ransom
Keyword(s):  
Zoledronic Acid ◽  
Serum Calcium ◽  
Metastatic Disease ◽  
Parathyroid Carcinoma ◽  
Treatment Modalities ◽  
Common Finding ◽  
Rapid Control ◽  
Pleural Metastases ◽  
Life Threatening ◽  
Turnover Markers

e16004 Background: We report a case of inoperable metastatic parathyroid carcinoma with life-threatening hypercalcaemia. We achieved rapid control of calcium with denosumab. Methods: Our patient presented with complications of hyperparathyroidism. He underwent a partial parathyroidectomy and hemithyroidectomy. Parathyroid carcinoma was confirmed. There was no metastatic disease. A year later he was hypercalcaemic, 4.15 mmol/L (2.15-2.60 mmol/L), with elevated PTH and creatinine. FDG activity was seen on PET at the thyroid bed and retrocrural space. Extensive pleural metastases limited resection to debulking. The calcium and PTH remained elevated. Hydration and zoledronic acid had little effect. Cinacalcet 90mg QDS led to no improvement in calcium. Weekly zoledronic acid was used to keep his calcium below 4 mmol/L. Two cycles of cyclophosphamide, 5-flurouracil and dacarbazine led to no decline in the calcium. Denosumab is a fully human monoclonal IgG2 antibody with a high affinity and specificity to bind RANK ligand, mimicking Osteoprotegerin, competitively blocking the binding of RANK to its ligand to inhibit osteoclast activation. Results: 120mg was given subcutaneously. By day 8 the calcium had dropped to 2.66 mmol/L. After a second dose, the calcium was 2.33 mmol/L. Bone turnover markers were rapidly suppressed. The calcium was in the normal range for four months with improved renal function. Further denosumab will be guided by serum calcium. Conclusions: Parathyroid carcinoma is rare. The mainstay of treatment is resection, even in metastatic disease. Often the disease is refractory to medical management leading to complications of hypercalcaemia. There is limited evidence for chemotherapy and few strategies to manage resistant hypercalcaemia have been published. In this case refractory hypercalcaemia dramatically responded to denosumab. Denosumab does not require dose adjustment for renal impairment, a common finding with hypercalcaemia. In this case denosumab offered prolonged control of serum calcium. We propose that denosumab should be considered for patients with hypercalcaemia due to parathyroid cancer.

scholarly journals Parathyroid function and calcium concentration in serum of dexamethasone treated rabbits

2000 ◽  
Vol 24 (2) ◽  
pp. 121-133
Author(s):  
Mashi S. K. ◽  
Al-Ar'rak J. K.
Keyword(s):  
Parathyroid Gland ◽  
Physiological Saline ◽  
Secretory Activity ◽  
Treated Group ◽  
Control Group ◽  
Tissue Samples ◽  
Functional Changes ◽  
Parathyroid Function ◽  
Physiological Saline Solution ◽  
Therapeutic Doses

This experiment was carried out to determine structural functional changes which could be caused due to uses of dexamethasone at daily therapeutic doses in rabbits for a reasonable period. Ten adult male rabbits were randomly divided into two equal groups control and treatment. Animals of the treatment group were intramuscularly injected with dexamethasone sod. citrate (0.06 mg/100g.B.W.) for 14 days. Animals of control group received the same dose of normal physiological saline solution blood samples were collected every other day until 48 hours after the last injection serum was isolated for measurement of calcium concentrations. At the end of the experiment tissue samples from the parathyroid glands were isolate to prepare histological stained sections . Dexamethasone did not cause significant changes in serum concentration of calcium of treated group compared with its concentrations in control group. Light microscopic examination of hematoxylin eosion stained sections of parathyroid gland showed enlargement and increase in number of light chief cells indicating increased secretory activity due to dexamethasone injection. The increased of parathyroid gland activity explain the maintenance of total calcium level within the normal range in spite of the expected hypocalcemia due to dexamethasone administration. 

scholarly journals Case Report: Abdominal Lymph Node Metastases of Parathyroid Carcinoma: Diagnostic Workup, Molecular Diagnosis, and Clinical Management

2021 ◽  
Vol 12 ◽  
Author(s):  
Christina Lenschow ◽  
Carmina Teresa Fuss ◽  
Stefan Kircher ◽  
Andreas Buck ◽  
Ralph Kickuth ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastases ◽  
Biochemical Recurrence ◽  
Parathyroid Carcinoma ◽  
Histopathological Examination ◽  
Diagnostic Workup ◽  
Endocrine Tumors ◽  
Abdominal Lymph Node ◽  
Surgical Specimen ◽  
Node Metastases

Parathyroid carcinoma (PC) is an orphan malignancy accounting for only ~1% of all cases with primary hyperparathyroidism. The localization of recurrent PC is of critical importance and can be exceedingly difficult to diagnose and sometimes futile when common sites of recurrence in the neck and chest cannot be confirmed. Here, we present the diagnostic workup, molecular analysis and multimodal therapy of a 46-year old woman with the extraordinary manifestation of abdominal lymph node metastases 12 years after primary diagnosis of PC. The patient was referred to our endocrine tumor center in 2016 with the aim to localize the tumor causative of symptomatic biochemical recurrence. In view of the extensive previous workup we decided to perform [18F]FDG-PET-CT. A pathological lymph node in the liver hilus showed slightly increased FDG-uptake and hence was suspected as site of recurrence. Selective venous sampling confirmed increased parathyroid hormone concentration in liver veins. Abdominal lymph node metastasis was resected and histopathological examination confirmed PC. Within four months, the patient experienced biochemical recurrence and based on high tumor mutational burden detected in the surgical specimen by whole exome sequencing the patient received immunotherapy with pembrolizumab that led to a biochemical response. Subsequent to disease progression repeated abdominal lymph node resection was performed in 10/2018, 01/2019 and in 01/2020. Up to now (12/2020) the patient is biochemically free of disease. In conclusion, a multimodal diagnostic approach and therapy in an interdisciplinary setting is needed for patients with rare endocrine tumors. Molecular analyses may inform additional treatment options including checkpoint inhibitors such as pembrolizumab.

scholarly journals Parathyroid Hormone 1–84 Alters Circulating Vascular Endothelial Growth Factor Levels in Hypoparathyroidism

2014 ◽  
Vol 99 (10) ◽  
pp. E2025-E2028 ◽  
Author(s):  
Natalie E. Cusano ◽  
Mishaela R. Rubin ◽  
Chiyuan Zhang ◽  
Laura Anderson ◽  
Elizabeth Levy ◽  
...  
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Parathyroid Gland ◽  
Menopausal Status ◽  
Vascular Endothelial ◽  
Entire Cohort ◽  
Parathyroid Function ◽  
Postoperative Hypoparathyroidism ◽  
Gland Function ◽  
Endothelial Growth Factor

Abstract Context: We previously reported on four patients treated with PTH(1–84) who recovered from postoperative hypoparathyroidism many years after onset. Because vascular endothelial growth factor (VEGF) has been shown to be necessary for the induction of PTH-mediated angiogenesis, we postulated a possible role for VEGF in the recovery of parathyroid function in these subjects. Objective: Our objective was to measure VEGF levels in subjects with hypoparathyroidism who regained parathyroid gland function and matched controls. Setting and Design: Subjects with hypoparathyroidism who regained parathyroid gland function were each matched to two hypoparathyroid controls by postoperative etiology, age (within 5 y), menopausal status, and duration of hypoparathyroidism. We measured serum VEGF levels at baseline and through 48 months of PTH(1–84) therapy. Results: VEGF levels increased after the initiation of PTH(1–84) therapy for the entire cohort, from 309.7 ± 162 pg/ml at baseline to 380.2 ± 178 pg/ml at 12 months (P = .03). Levels trended downward thereafter. There were no significant differences in VEGF levels between the subjects with recovery of parathyroid function and the matched controls. Conclusions: PTH(1–84) alters serum VEGF levels in subjects with hypoparathyroidism. Additional investigation is necessary to understand the mechanisms by which some subjects with postoperative hypoparathyroidism recover parathyroid gland function.

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